Newsletter May/June 2023

Governor Cooper’s administration and the State Legislature have taken great strides in improving access to affordable healthcare services to people with intellectual and developmental disabilities (I/DD) as well as the traditionally uninsured population of the state. Three new programs offer real hope for improved access, funding and delivery of medical and mental health services including:

• Medicaid Expansion – Set to become law with the passage of the new state budget, Medicaid will be expanded to provide healthcare insurance coverage and provide better access to care for people with disabilities, including Fragile X, and low-income families across the state. People with I/DD require wide-ranging and costly healthcare needs that will be covered by Medicaid in the immediate future. The expanded coverage offers affordable health insurance for complex behavior health and mental health services that are critical to people with disabilities and low-income families especially in the state’s rural areas. Beginning October 1, many of the Medicaid recipients will begin receiving coordinated and synchronized healthcare services and supports from a broad range of specialists and providers managed by a single care manager.
• Tailored Plan Management – Set to be launched in October, this is a Medicaid service option that provides a designated Care Manager who manages a network of resources and supports to achieve better health and quality of life outcomes for Medicaid recipients. The new delivery model provides individualized and coordinated care for people living with intellectual and developmental disabilities (including Fragile X), mental illness, substance use disorders or traumatic brain injuries. Tailored Plans reach beyond standard Medicaid plans to provide critical therapies and services needed by these specific groups of people. The program administered by the LME/MCOs who serve different sections of the state (See next article for details). If you are eligible or you or a dependent have a tailored plan, you will get a notice in the mail from your LME/MCO. To learn more, visit https://ncmedicaidplans.gov/learn/benefits-and-services/tailored-plan-services
• 1915 (i) State Plan Option – A new 1915 (i) Medicaid option provides home and community-based services for qualifying individuals with I/DD, significant behavioral health needs and for those requiring acute-care medical services like dental services, skilled nursing services and long-term services. This includes respite, supported employment and environmental modifications in home and community-based settings. This program combines existing individual support and transitional living services into a person-centered, tailored plan for children ages 3 to 20 with severe SUD, diagnosed children residing in therapeutic foster care or other accommodation at risk of losing their placement and adults with traumatic brain injuries. Services will be provided by local management entities/managed care organizations (LME/MCOs) and are also available through Tailored Plans, NC Medicaid Direct, the Children and Families Specialty Plan and the Tribal Option for beneficiaries who qualify. For more information, go to https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915i/index.html

The combination of these three programs will make more healthcare and support services available to families and individuals with disabilities. You may want to thank your State Legislature and the Governor for their support of these new programs.